Provider Demographics
NPI:1336200351
Name:PIMIENTA, JORGE F (MD)
Entity type:Individual
Prefix:
First Name:JORGE
Middle Name:F
Last Name:PIMIENTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11760 SW 40TH ST
Mailing Address - Street 2:SUITE 542
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-3582
Mailing Address - Country:US
Mailing Address - Phone:305-554-7575
Mailing Address - Fax:305-554-9499
Practice Address - Street 1:11760 SW 40TH ST
Practice Address - Street 2:SUITE 542
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-3582
Practice Address - Country:US
Practice Address - Phone:305-554-7575
Practice Address - Fax:305-554-9499
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME67199174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL26395Medicare ID - Type Unspecified
F94945Medicare UPIN